EPIDEMIOLOGY OF RURAL TRAUMATIC DEATH IN CHILDREN - A POPULATION-BASED STUDY

To determine the epidemiology of traumatic death in pediatric patients in a rural state, we reviewed all deaths caused by injury in victims <19 years old between 1985 and 1990. We hypothesized that mortality wo uld be higher than equivalent populations in urban areas. During the s tudy period, 5,322 children were hospitalized for trauma (14% of total admissions for children in the state) and 36 died (0.67%). For this s ubgroup, head injury was the most common cause of death (72%). When co mpared with data from the National Pediatric Trauma Registry from urba n centers, the mortality rate for hospitalized children in this rural state was lower (0.67% vs. 2.7%, p < 0.001), On review of the populati on-based statistics for the entire state, we found that these numbers were deceivingly low. In all, 731 children died during the study perio d, of which 283 were determined by autopsy or coroner's report to have died of trauma (38.7%). Eighty-seven percent of children who died nev er reached the hospital. Mortality (age-adjusted) was highest in the 1 5- to is-year-olds (68.5 of 100,000), then <1-year-old (26.8 of 100,00 0), 1- to 5-year-olds (15.6 of 100,000), and 5- to 14-year-olds (11.8 of 100,000), which significantly exceeds the predicted national averag es for these age groups. In addition, the overall mortality for childr en in this state (29.5 of 100,000) doubled that estimated for New York City (13.3 of 100,000), confirming the allegation that pediatric deat hs from injury in a rural setting are more frequent than that encounte red in an urban setting, in spite of the recent increase in gunshot wo unds in the urban population. Data on children admitted to the hospita l in this rural state underestimate mortality caused by trauma. Popula tion-based studies are therefore optimal to assess incidence and outco me accurately. Although overall mortality in children is higher than u rban rates, medical care in this population compares well with statist ics reported in predominantly urban centers for similar Injury Severit y Scored patients. These data substantiate that programs to improve tr auma mortality in this rural state must be concentrated on enhancing a ccess to the hospital system to have a significant effect.